经会阴二维超声对尿道中段悬吊术后不同材料吊带的形态及疗效研究

发布时间：2018-05-02 16:06

本文选题：压力性尿失禁 + 网片　；参考：《复旦大学》2014年硕士论文

【摘要】：目的尿道中段悬吊术已经成为压力性尿失禁的手术金标准,本研究的目的是建立利用二维超声监测吊带形态变化的手段,研究吊带形态与疗效的关系,并以此为主要依据对比分析聚丙烯材料(Polypropylene, PP)与聚偏氟乙烯材料(polyvinylidene fluoride, PVDF)的吊带在经闭孔尿道中段悬吊术中、体外及动物体内所体现出的生物学及力学特性。方法通过经会阴B超回顾性研究尿道中段悬吊术后的患者吊带的形态改变,参与研究患者83人,比较两种不同材料吊带在B超下的截面宽度、与尿道距离及Valsalva运动时的位移,并分析这些参数与疗效及并发症的联系。对两种吊带进行了力学实验以了解其力学特性。同时,两种吊带被分别植入大鼠的腹壁及阴道前壁下方,在15,30,60天后吊带周围组织被取出并评估炎症反应。结果手术主观改善率91.6%,没有阴道侵蚀等严重并发症出现,经会阴B超检查下PP组吊带截面宽度为8.22±1.84mmm,PP组吊带截面宽度为9.49±1.60m m,两组之间的差异有统计学意义(P0.001),PVDF组的皱缩程度大于PVDF组(P0.001),且吊带截面宽度及皱缩程度与术后时间无有意义的线性关系(P0.05)。PP组吊带与尿道的距离为5.93±150mm, PVDF组吊带与尿道的距离为5.62±184mm,该数值与术后时间无有意义的线性关系(P0.05)。局部炎症细胞反应方面,PP和PVDF吊带拥有类似的表现(PO.05)。力学特性方面,PP材料吊带的塑性变形率和弹性恢复率优于PVDF材料吊带,但初始模量远低于PVDF材料吊带,平均末次预加张力后伸长也高于PVDF材料吊带,同时,PP材料吊带在同样纵向应力时横向皱缩率也较高。结论使用经会阴二维超声观察吊带形态是一种可行的手段。PP吊带比PVDF吊带更易出现皱缩且皱缩程度更大,其中,术中或术后极短时间内出现的皱缩占据吊带皱缩的绝大部分,之后的皱缩过程缓慢且不明显,这一皱缩是否会对术后并发症的产生和发展产生影响需要进一步的研究证实。在泌尿道/生殖道侵蚀、手术疗效、炎症细胞反应等方面PP材料及PVDF材料的吊带并没有表现出明显差异,PVDF材料的吊带可能会是原有PP材料吊带的一种优秀的替代材料。
[Abstract]:Objective Urethral suspension has become the gold standard of stress urinary incontinence. The purpose of this study was to establish a method to monitor the shape of the sling by two-dimensional ultrasound, and to study the relationship between the shape of the sling and the curative effect. The biological and mechanical properties of polypropylene (PP) and polyvinylidene fluoride (PVDF) were analyzed in vitro and in vivo. Methods the morphological changes of suspensions were studied retrospectively by transperineal B-mode ultrasonography. 83 patients were involved in the study. The cross-section width of two different material sling under B-ultrasound, the distance between urethra and the displacement of Valsalva movement were compared. The relationship between these parameters and curative effect and complications was analyzed. Mechanical experiments were carried out on two kinds of suspenders to understand their mechanical properties. At the same time, the two suspensions were implanted into the abdominal wall and the anterior wall of vagina, respectively. The tissue around the sling was removed and the inflammatory response was evaluated 60 days later. Results the subjective improvement rate of operation was 91.6 and there were no serious complications such as vaginal erosion. After transperineal B-ultrasound examination, the width of sling section in PP group was 8.22 卤1.84 mm ~ (-1) PP group was 9.49 卤1.60 mm ~ (-1) m ~ (-1), the difference between the two groups was statistically significant (P < 0.05). The shrinkage degree of PVDF group was higher than that of PVDF group (P ~ (0.001), and the width and degree of sling band cross-section and the postoperative time were higher than those in PVDF group. There was no significant linear relationship between the sling and urethra in the PP group (5.93 卤150mm) and the PVDF group (5.62 卤184mm). There was no significant linear relationship between this value and the postoperative time. In terms of local inflammatory cell response, PP and PVDF sling showed similar manifestations. In terms of mechanical properties, the plastic deformation rate and elastic recovery rate of PP sling are better than that of PVDF material sling, but the initial modulus is much lower than that of PVDF material sling, and the average elongation of PVDF material sling is also higher than that of PVDF material sling after the last pretension. At the same time, the sling of PP material has higher transverse shrinkage rate under the same longitudinal stress. Conclusion it is a feasible method to observe the shape of sling by transperineal two-dimensional ultrasound. PP sling is more prone to shrinkage and the degree of shrinkage is greater than that of PVDF sling. Among them, the shrinkage occurred in a very short period of time during or after operation is the majority of the sling band shrinkage. The process of subsequent shrinkage is slow and not obvious. Whether this shrinkage will have an effect on the occurrence and development of postoperative complications needs further study to confirm. In the aspects of urinary / genital tract erosion, surgical efficacy and inflammatory cell reaction, there was no obvious difference between the suspensions of PP and PVDF materials.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.7

【共引文献】